The Wound Evaluation

1
Basic Wound Care
Kevin P. Kilgore, M.D., FACEP
2
Overview

• The process of wound care involves
• evaluation
• plan
• action

Kevin P. Kilgore, M.D., FACEP
3
Objectives

• Objectives
• Discuss the process of wound evaluation
• Review the materials used for wound repair
• Discuss simple wound closure
• Discuss wound aftercare items

Kevin P. Kilgore, M.D., FACEP
4
History

• When did this happen?
• time
• Where did this happen?
• location
• How did this happen?
• mechanism

Kevin P. Kilgore, M.D., FACEP
5
History

• allergies
• current medications
• pre-existent medical conditions
• immunization status for tetanus

Kevin P. Kilgore, M.D., FACEP
6
The golden period
History

• A misnomer with
• meticulous debridement
• copious irrigation
• antibiotic coverage

Kevin P. Kilgore, M.D., FACEP
7
Mechanism
History

• shear
• tension
• compression
• missile injuries a combination of shear, tensile,
  and compressive

Kevin P. Kilgore, M.D., FACEP
8
Shear
History

• Sharp tissue division
• Little energy required
• Lower infection rate
• Cosmetics acceptable

Kevin P. Kilgore, M.D., FACEP
9
Tension
History

• Compression injury
• Less than 90o
• Triangular flap
• Increased infection
• Poor result

Kevin P. Kilgore, M.D., FACEP
10
Compression
History

• Crushing injury
• Significant injury
• Increased infection
• Poor results

Kevin P. Kilgore, M.D., FACEP
11
Examination

• Environment
• protective dressing
• gloves, gowns, goggles
• good lighting
• goal - determine extent of injury

Kevin P. Kilgore, M.D., FACEP
12
Extent of injury
Examination

• amount of tissue loss
• tissue viability
• depth of the wound
• presence of any associated injuries

Kevin P. Kilgore, M.D., FACEP
13
Depth of injury
Examination

• Injury to underlying structures?
• nerves
• tendons
• muscles
• bone

Kevin P. Kilgore, M.D., FACEP
14
Lacerations over bones
Examination

• probe with a gloved finger to determine whether
  or not there is a fracture.
• If a wound overlies a fracture site an open
  fracture should be assumed present.

Kevin P. Kilgore, M.D., FACEP
15
Deep structure injury
Examination

• puncture wounds of the head, neck and torso must
  be managed on the premise that there has been
  penetration and damage to vital structures.

Kevin P. Kilgore, M.D., FACEP
16
Anesthesia
Techniques

• Topical
• TAC or XAP
• Local
• 1 buffered xylocaine
• bupivocaine
• Regional (nerve block)
• 1 buffered xylocaine
• bupivocaine

Kevin P. Kilgore, M.D., FACEP
17
Irrigation debridement
Techniques

• The single most important element of basic wound
  care.
• Intent
• remove devitalized tissue
• remove potential nidus for infection

Kevin P. Kilgore, M.D., FACEP
18
Preparation
Techniques

• Generally, an iodophor solution (e.g., Betadine
  10)
• Sterile draping is imperative

Kevin P. Kilgore, M.D., FACEP
19
Instruments
Techniques

• four basic instruments
• needle-holder
• forceps
• scissors
• towels

Kevin P. Kilgore, M.D., FACEP
20
Suture materials
Techniques

• Absorbable Sutures
• employed below the skin
• Polyglycolic acid (Dexon)
• Nonabsorbable Sutures
• nylon (dermalon, ethilon)
• surgelene
• novifyl

Kevin P. Kilgore, M.D., FACEP
21
Other closure materials
Techniques

• Steri-Strips and Shur-strips
• Surgical staples
• Dermabond

Kevin P. Kilgore, M.D., FACEP
22
Size Selection
Techniques

• face, hands or feet - 5-0 and 6-0
• trunk and extremity - 4-0 and 5-0

Kevin P. Kilgore, M.D., FACEP
23
Suture techniques
Techniques

• Subcuticular Closure
• Dexon or Vicryl, are used for this deep layer
  closure.
• Cuticular Closure

Kevin P. Kilgore, M.D., FACEP
24
Subcuticular Closure
Techniques
Kevin P. Kilgore, M.D., FACEP
25
Simple Suture
Techniques

• easiest to learn
• safest most effective
• more time needed

Kevin P. Kilgore, M.D., FACEP
26
Wound Edge Eversion
Techniques
Kevin P. Kilgore, M.D., FACEP
27
Instrument Tie
Techniques
Kevin P. Kilgore, M.D., FACEP
28
Completing Care

• Dressings
• Immobilization
• Medications
• Antibiotics
• Tetanus Prophylaxis
• Rabies Prophylaxis
• Discharge Instructions

Kevin P. Kilgore, M.D., FACEP
29
Suture Removal
Completing Care

• face 3 to 5 days
• ear 4 to 6 days
• scalp 7 to 12 days
• trunk 7 to 12 days
• arms 10 to 12 days
• legs 10-12 days
• hand 10 to 12 days
• feet 10 to 14 days

Kevin P. Kilgore, M.D., FACEP
30
Objective Review

• Discuss the process of wound evaluation
• Review the materials used for wound repair
• Discuss simple wound closure
• Discuss wound aftercare items
• Remember to remove your sharps from the tray

Kevin P. Kilgore, M.D., FACEP
31
Now to the Lab